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Differences in Racial and Ethnic Disparities Between First and Repeat Kidney Transplantation.

Shaifali Sandal1,2,3, JiYoon Ahn4, Yusi Chen5

  • 1Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.

Transplantation
|May 21, 2024
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Summary
This summary is machine-generated.

Racial and ethnic disparities in kidney transplantation access are greater for repeat transplants than for first-time transplants. Black and Hispanic patients with graft failure do not benefit from repeat kidney transplants, indicating persistent systemic barriers.

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Area of Science:

  • Nephrology
  • Transplantation
  • Health Equity

Background:

  • Patients with graft failure may have better access to repeat kidney transplantation (re-KT) than transplant-naive patients accessing first KT.
  • It is unknown if this potential advantage is equitably distributed across racial and ethnic groups.
  • This study aimed to compare racial/ethnic disparities in access to re-KT versus first KT.

Purpose of the Study:

  • To compare the magnitude of racial/ethnic disparities in access to repeat kidney transplantation (re-KT) versus first kidney transplantation (first KT).
  • To investigate whether the previously observed advantage in re-KT access for patients with graft failure is equitably distributed.
  • To identify persistent systemic barriers affecting transplant equity.

Main Methods:

  • Utilized the United States Renal Data System (USRDS) from 1995 to 2018.
  • Included 104,454 White, Black, and Hispanic patients with graft failure and 2,357,753 transplant-naive dialysis patients.
  • Employed adjusted Cox regression to estimate disparities in access to first and re-KT, and used a Wald test to compare disparity magnitudes.

Main Results:

  • Black patients faced inferior access to waitlisting and receiving both first KT and re-KT.
  • Racial/ethnic disparities in waitlisting and receiving re-KT were greater than for first KT (Pinteraction < 0.001 for receiving).
  • Hispanic patients showed greater disparities in waitlisting for re-KT compared to first KT, but similar disparities in receiving re-KT versus first KT.

Conclusions:

  • Unlike White patients, Black and Hispanic patients with graft failure do not experience improved access to repeat kidney transplantation.
  • These findings suggest that structural and systemic barriers persist for racialized patients seeking re-KT.
  • Systemic changes are necessary to achieve equitable access to kidney transplantation for all patients.